DESCRIPTION: (Applicant's Abstract) This K01 application will support the career development of the candidate as an investigator in the area of HIV prevention. This proposal focuses on the development of a hospital-based infectious disease risk reduction program for out-of-treatment injection drug users (IDUs). Injection drug users are at high risk for human immunodeficiency virus (HIV) infection, hepatitis B and C, skin and soft tissue infections, and other infectious diseases. Because these infectious disease are transmitted by specific risky behaviors, the design and implementation of HIV risk-reduction strategies for IDUs are of critical importance. A randomized, clinical trial will be conducted to examine the effectiveness of the components of an infectious disease prevention program designed to reduce HIV risk behaviors and to improve the general health of injection drug users. The specific aims of the study are to assess the impact of the intervention on patient outcomes, health service utilization, and health care costs, and to develop printed materials on safe self-injection practices for English and Spanish- speaking IDUs. Research participants will be out-of-treatment injection drug users seeking medical care in a hospital-based emergency department. They will be randomly assigned to one of four conditions: 1) hospital-based syringe exchange and standard HIV risk reduction education; 2) enhanced HIV risk reduction education (including education on safe self-injection practices); 3) hospital-based syringe exchange and enhanced HIV risk reduction education (including education on safe self injection practices); 4) referral to a community-based syringe exchange program. Assessments will occur before randomization and at 6 and 12 months. It is hypothesized that research participants who are assigned to the hospital-based syringe exchange and enhanced HIV risk education group will show a greater reduction in risky injection drug use and in injection drug use-related infectious diseases than those who are assigned to each of the other groups. It is also expected that those who are in the syringe exchange and enhanced HIV risk education group will show a greater reduction in the use of emergency and inpatient medical services and in related health care costs.